THE CONTENTS OF THE ABDOMEN. 



141 



the qiradratus lumborum muscle. Such perinephritic abscesses and similar ones behind the 

 kidney may extend upward, affecting the pleura (pleurisy), or the abscess may gravitate to the 

 iliac fossa and pursue one of a number of subperitoneal courses similar to those taken by a retro- 

 cecal (perityphlitic) abscess (see page 137). 



The method 0} reaching the kidney from behind may be discerned from a study of Fig. 69. 

 An incision is made along the outer margin of the sacrolumbalis muscle (i. e., the outer portion 

 of the iliocostalis of the erector spinae), extending from the last rib to the crest of the ilium. 

 After dividing the skin, the superficial fascia, the latissimus dorsi muscle, and the posterior layer 

 of the lumbar fascia, the edge of the sacrospinalis (erector spinae) muscle is displaced inward, 



Vertebral arch- 



Central canal of 

 vertebra 



Right kidney 



Vena cava inferior 

 Liver' 



Ascending colon 

 Aorta 



Inferior mesenteric 

 artery 



Pancreas 

 Portal vein 

 Intestinal branches 

 of superior mesen- 

 teric artery 



Gall-bladder 

 Duodenum (de- 

 scending portion) 



Latissimus dorsi 



muscle 

 Erector spin r 



muscle 



Quadratus lumbo- 

 rum muscle 

 Left kidney 

 Psoas muscle 

 Cartilage between 

 ad and 3d lum- 

 bar vertebras 

 Obliquus exteraus 



muscle 



Descending colon 

 Small intestine 



-If Peritoneal cavity 



Transversalis ab- 

 dominis muscle 

 Small intestine 



Rib 



Rectus abdominis 

 muscle 



FIG. 69. A cross-section of the abdomen in the inferior renal region 



the anterior layer of the lumbar fascia is divided, and the quadratus lumborum muscle is 

 exposed. The kidney is reached by dividing this muscle or by displacing its external border. 



The suprarenal bodies rest upon the superior poles of the kidneys. They are also in rela- 

 tion with the crura of the diaphragm. The right suprarenal capsule, more frequently triangular 

 in shape, borders upon the liver [that is, upon the posterior surface of the right lobe. ED.] (im- 

 pressio suprarenalis, page 131) and upon the inferior vena cava (Fig. 67) ; the left one i 

 with the cardia of the stomach. 



The abdominal portion of the ureter extends from the pelvis of the kidney to the iliopectmea 

 line of the pelvis and is situated behind the peritoneum. It runs downward and somewhat 

 inward upon the psoas muscle, and crosses the common iliac vessels near their bifurcation, 

 ureter is placed in front of the vessels and may be easily exposed in this situation. The spermati 

 vessels are also behind the peritoneum and cross in front of the ureter at about the middle of the 



